OTA 2006 Posters
Scientific Poster #7 Polytrauma
Use of the Vacuum-Assisted Closure (VAC) Device in the Treatment of Open
Fractures
Arthur L. Malkani, MD (n); Benjamin W. Burkett, MD (n); Craig
S. Roberts, MD (n); David Seligson, MD (n);
University of Louisville, Department of Orthopaedic Surgery, Louisville,
Kentucky, USA
Purpose: Open fractures following high-energy trauma present a challenge
to orthopaedic traumatologists. The management of soft-tissue loss is critical
in preventing infection and restoring blood supply for healing. Recently
the use of a vacuum-assisted closure (VAC) device has become more common
to assist in the management of large soft-tissue defects. The purpose of
this study was to review complications following treatment of open fractures
with soft-tissue defects using a wound VAC device prior to definitive wound
closure.
Methods: 23 patients (17 males and 6 females) with open fractures
and soft-tissue defects were reviewed for specific outcome measures of infection
and nonunion. 18 patients had open tibia fractures, 3 had open fractures
of the ankle, 1 had isolated open fractures/degloving injury of the foot,
and 3 had open fractures about the upper extremity. All patients required
either skin graft or flap coverage of the soft-tissue defect. Primary closure
could not be accomplished in this group of patients due to the extent of
soft-tissue trauma. For intermittent wound coverage, all patients were treated
with a wound VAC device for variable periods of time, from days to weeks.
Results: Six patients (26%) in our review developed a deep wound
infection. Two of the patients who developed an infection also progressed
to a nonunion. Three additional patients also developed a nonunion. 16 (70%)
of the original 23 patients progressed to union after their soft-tissue
coverage and achieved bony union without complications.
Conclusion: Use of wound VAC devices is becoming more widespread
for the coverage of soft-tissue wounds before definitive coverage is attempted.
However, there is little clinical evidence or literature to support their
use in this clinical setting. Despite the beneficial effects of a VAC device,
we still experienced a high infection rate in this difficult group of patients
with open fractures in whom primary closure could not be accomplished. Although
we still use a VAC suction device in cases where a temporary soft-tissue
envelope is required prior to definitive coverage, we recommend its use
with caution until a prospective study is accomplished to determine the
true benefits of this device.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.